Synopsis
Recognise low-trauma fracture as a sentinel event, investigate skeletal and fall contributors without delaying treatment in high-risk people, and deliver coordinated fracture-liaison, osteoporosis, exercise and safety care that prevents the next fracture.
- A fragility fracture usually follows force equivalent to a fall from standing height or less and is a clinical signal for prompt secondary prevention.
- First-line after acute care is fracture-liaison or equivalent coordinated assessment of fracture site, prior fractures, falls, medicines, nutrition, secondary causes and future risk.
- Do not delay treatment simply to obtain DXA when an older person with a recent fragility fracture is already at high or very high risk and treatment is indicated.
Key red flags
Inability to weight bear or pain on hip rotation after a standing-height fall requires hip-fracture assessment even if the initial radiograph is normal.
Groin pain, shortened externally rotated leg or inability to weight bear after low trauma requires urgent hip imaging.
Investigation priorities
Define the acute injury and stability.
Management branches
A low-trauma fracture is confirmed or strongly suspected.
- Complete acute fracture care and identify previous and occult vertebral fractures, falls and secondary-cause clues.
- Estimate risk and obtain DXA only when it will refine management without delaying indicated therapy.
Key medicines
Alendronic acid70 mg orally once weekly; take on rising after an overnight fast with plain water, remain upright and avoid food, drink and other medicines for at least 30 minutes.
Zoledronic acid5 mg by intravenous infusion once yearly, with infusion duration and renal checks according to the product information.